Systematic review with meta‐analysis: risk factors for Barrett's oesophagus in individuals with gastro‐oesophageal reflux symptoms

Summary Background Gastro‐oesophageal reflux is considered the main risk factor for Barrett's oesophagus. The role of other potential risk factors for the development of Barrett's oesophagus in patients with gastro‐oesophageal reflux symptoms is controversial. Aims To perform a systematic review and meta‐analysis examining risk factors in development of Barrett's oesophagus. Methods Medline, Embase and Embase Classic were searched (until December 2020) to identify cross‐sectional studies reporting prevalence of Barrett's oesophagus based on presence of one or more proposed risk factors in individuals with gastro‐oesophageal reflux symptoms. Prevalence of Barrett's oesophagus was compared according to presence or absence of each risk factor in individuals with gastro‐oesophageal reflux symptoms. Results Of 7164 citations evaluated, 13 studies reported prevalence of Barrett's oesophagus in 11 856 subjects. Pooled prevalence of histologically confirmed Barrett's oesophagus in individuals with gastro‐oesophageal reflux symptoms in all studies was 7.0% (95% CI 4.8% to 9.6%). Prevalence was higher in subjects with hiatal hernia (OR 2.74; 95% CI 1.58 to 4.75) and in those who drank alcohol (OR 1.51; 95% CI 1.17 to 1.95). Other features including non‐steroidal anti‐inflammatory drugs and/or aspirin use (OR 1.19; 95% CI 1.00 to 1.42), smoking (OR 1.14; 95% CI 0.96 to 1.35) or obesity (OR 1.10; 95% CI 0.92 to 1.33) were not significantly associated with Barrett's oesophagus. Conclusions The prevalence of Barrett's oesophagus in individuals with gastro‐oesophageal reflux symptoms was higher in those who drank alcohol, although this association was modest. The strongest association found was between hiatal hernia and Barrett's oesophagus. Other potential risk factors assessed in this study did not appear to be associated with presence of Barrett's oesophagus among individuals with gastro‐oesophageal symptoms. The associations between most of the risk factors and the presence of Barrett's oesophagus in patients with gastro‐oesophageal reflux symptoms are weak. The strongest association was found with presence of hiatal hernia and alcohol drinking. Other potential risk factors did not appear to be associated with Barrett's oesophagus.